Vaginal ring for birth control: Effectiveness & side effects

How the ring works

The ring works in a similar way to the contraceptive pill, by releasing estrogen and progestogen into your bloodstream, which prevents pregnancy by stopping your ovaries from releasing an egg cell each month. 

These hormones also thicken your cervical mucus, which makes it more difficult for sperm to reach any eggs, while also thinning the lining of your uterus to inhibit implantation. This makes it less likely for a fertilized egg to implant and develop into a pregnancy.

You’ll typically insert a ring and then leave it in place for 21 days, after which you have a 7-day break, much like the contraceptive pill. During this 7-day break, it’s normal to have what’s known as a withdrawal bleed. After 7 days, you’ll insert a new ring, and the cycle will start again. You’ll be protected from pregnancy both during the 3 weeks you have the ring in place, and for the week you do not.

You can also choose to have a shorter break without using the ring, or you can choose not to have a break at all – neither option will affect the effectiveness of the ring.

How effective is the vaginal ring?

With perfect use, meaning you use the ring according to instructions, it’s over 99% effective at preventing pregnancy. If the ring isn’t used properly, the chances of getting pregnant become higher. This is called typical use and includes forgetting to reinsert the ring after the ring-free week, or not inserting it properly. With typical use, the ring is 93% effective at preventing pregnancy, meaning 7 out of 100 women using this method will become pregnant each year. 

Who can use the vaginal ring?

The ring is suitable for most people, but not everyone. Some of the reasons you may not be able to use the ring include:

• If you think you could be pregnant
• If you’re over the age of 35 and a smoker
• You take certain medicines (e.g., some epilepsy drugs and HIV medication can make the ring less effective)
• You have migraines with aura (visual changes or tingling in your hands or face) 
• A heart abnormality or hypertension
• Have breast cancer or have had it in the last five years
• Have had a blood clot in the past

These are just a few of the reasons that could prevent you from using the vaginal ring, so it’s always best to check with your healthcare provider to find out whether it’s the right option for you.

Advantages of the vaginal ring

As with every method of birth control, there are advantages and disadvantages to using the ring. These include:

• Convenience: If you don’t want to, or find it hard to remember to, take a pill every day, then the ring can be a convenient option. Once it’s inserted, it’ll stay in place for three weeks, providing you with continuous protection without having to think about it each day.

• It doesn’t interrupt sex: Because the ring protects against pregnancy for several weeks at a time, you don’t need to worry about it before sex, unlike some other methods of birth control like condoms.

• Menstrual regulation: If you have heavy periods or an irregular menstrual cycle, then the ring may help to lighten your periods and give you a more regular cycle. The hormones in the ring may also help to reduce menstrual cramps, and if you want to skip or delay your period, you can easily and safely do so with the ring. It may also be helpful to regulate PMS symptoms such as mood changes, although the ring has its own side effects. 

• Lessens acne: The ring can also reduce breakouts and give you clearer skin.

Disadvantages of the vaginal ring

While the vaginal ring has several advantages, it also comes with certain disadvantages that individuals should consider when choosing a contraceptive method. These include:

• Reliance on users: The vaginal ring can only be effective if it’s used consistently and correctly. That means it’s up to you to insert and remove it properly, and according to the prescribed schedule, in order for it to be effective against pregnancy.

• It doesn’t protect against STIs: The ring doesn’t protect against sexually transmitted infections, so you may need to use a barrier method of contraception, like condoms, in addition to the ring.

Vaginal ring side effects

There may also be some vaginal ring side effects, both good and bad. Common side effects include:

• Spotting or irregular bleeding
• Sore breasts
• Nausea
• Headaches
• Mood changes
• Reduced acne/clearer skin

Risks of the ring

There are some rarer risks to using the ring, which may affect a small number of people. They aren’t common, but it’s still important to be aware of the potential risks. These include:

• Deep vein thrombosis, arterial thrombosis, heart attack or stroke – but the risk is greatest if you are immobile for long periods of time, are very overweight, or your immediate family members had thrombosis before the age of 45, are diabetic, smoke, have hypertension or migraine with aura
• A small increased risk of breast cancer
• A small increased risk of cervical cancer

You should always consult your healthcare provider before starting any new form of birth control, to ensure it’s safe for you to use.

How do you make the ring work best for you?

When you start using the ring, if you insert it within the first five days of your menstrual cycle, you’ll be protected against pregnancy straight away.

If you start using it at any other time in your cycle, you’ll need to use an additional form of contraception for the first seven days after inserting it.

How to insert the vaginal ring

Inserting the ring may take a little trial and error to get it right, and it can feel strange at first if you’re not used to doing it. To insert your ring:

• Wash your hands thoroughly
• Find a comfortable position – this will depend on your anatomy. Some people like to lie down to insert it, while others prefer squatting or standing with one foot up on the toilet seat
• Squeeze the ring between your thumb and index finger, then insert it into your vagina.
• Gently push it up into your vagina until it feels comfortable

You can leave it in place for three weeks, before removing it. This should be done on the same day of the week as you inserted it – and you might want to set a reminder on your phone to ensure you remember.

While you’re using the ring, it’s perfectly safe to have sex and use tampons. You or your partner may be able to feel the ring during sex, but it’s not harmful to either of you.

To remove the ring:

• Thoroughly wash your hands again
• Put your finger in your vagina until you feel the edge of the ring
• Hook your finger around the ring and gently pull it out

It shouldn’t be painful or uncomfortable to insert, wear or remove your ring. If you do feel any pain, or experience any bleeding while inserting or removing it, then talk to your doctor or OB-GYN.

Finding the right birth control method for you

Birth control is a very individual choice, and the implant may or may not be the right method for you. There are lots of different factors to consider when it comes to choosing contraception, from its effectiveness, to side effects, to family planning and lifestyle choice - but the most important thing is that we all have access to a multitude of birth control methods, and have the information we need to make an informed choice.

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